Neuroimaging of first-ever seizure

Ho, Ka; Lawn, Nicholas; Bynevelt, Michael; Lee, Judy; Dunne, John W.

doi:10.1212/cpj.0b013e3182a78f25

Cited by 53 publications

(50 citation statements)

References 7 publications

(6 reference statements)

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“…Although EEG has consistently been associated with a higher risk of recurrence after a first seizure, its role in our cohort might have been to clarify electroclinical diagnosis when other data were noncontributory and not a predictor of treatment in our study. In our cohort where all patients were diagnosed with epilepsy, a higher proportion of patients had epileptogenic lesions (over 40%) identified on neuroimaging compared to similar cohorts . These played a significant role in treatment initiation, while patients with epileptiform EEG findings were less likely to also have an epileptogenic lesion.…”

Section: Discussionmentioning

confidence: 66%

“…In our cohort where all patients were diagnosed with epilepsy, a higher proportion of patients had epileptogenic lesions (over 40%) identified on neuroimaging compared to similar cohorts. 10,16,17 These played a significant role in treatment initiation, while patients with epileptiform EEG findings were less likely to also have an epileptogenic lesion. Even in patients diagnosed after a single seizure without epileptogenic lesions, other underlying risk factors for seizure recurrence such as learning/developmental disability or a history of suspected seizures were more influential.…”

Section: Discussionmentioning

confidence: 99%

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Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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Objective To examine the factors and reasons influencing treatment initiation decisions in patients with newly diagnosed epilepsy. Methods We assessed antiseizure medication initiation decisions in adults with newly diagnosed epilepsy seen at first seizure clinics in Western Australia between 1999 and 2016 and followed to 2018. Results Of 610 patients (median age 40 years, 61.0% male), 426 (69.8%) were diagnosed after two or more seizures and 184 (30.2%) after a single seizure with risk factors for recurrence. Treatment was commenced in 427 patients (70.0%) at diagnosis, 112 (18.4%) during follow‐up, mostly after further seizures, whereas 71 (11.6%) remained untreated at last follow‐up. Elders (≥65 years, odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.62‐5.80), more seizures (OR = 3.48, 95% CI: 2.03‐5.96), and epileptogenic lesions on neuroimaging (OR = 2.15, 95% CI: 1.26‐3.68) had a higher likelihood of treatment at diagnosis. Patients with less than one seizure per year within the preceding year (OR = 0.40, 95% CI: 0.21‐0.73) and of higher socioeconomic status (OR = 0.985, 95% CI: 0.977‐0.994) were less likely to be treated. For 93 patients (15.2%), treatment was not recommended at diagnosis, most commonly because only a single seizure had occurred. Ninety patients (14.8%) declined recommended treatment, mostly because they were unconvinced of the need for treatment or the diagnosis. Significance Thirty percent of adults with newly diagnosed epilepsy were not immediately treated. Treatment initiation in this real‐world cohort was influenced by age, number of seizures prior to diagnosis, imaging findings, patient preferences, and socioeconomic status.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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Section: Discussionmentioning

confidence: 96%

“…As MRI is more sensitive than CT in detecting subtle lesions, it is not surprising that the number of pathological findings increases when MRI modalities are utilised. Several studies report an additional yield of 12-17% with MRI neuroimaging in patients with normal brain CT (Ho et al, 2013;Kapina et al, 2013). The EEG and neuroimaging abnormalities are useful in establishing the diagnosis of epilepsy syndromes and stratifying the risk of seizure recurrence.…”

Section: Low Yield Of Investigationsmentioning

confidence: 99%

Challenges in the first seizure clinic for adult patients with epilepsy

Jackson¹,

Teo²,

Seneviratne³

2016

Epileptic Disorders

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Aims. (1) To delineate the challenges in seizure diagnosis in the first seizure clinic setting for adult patients of a teaching hospital, and (2) quantify the diagnostic accuracy of the referral source and the yield of routine investigations, including blood tests, EEGs, and neuroimaging. Methods. We retrospectively reviewed medical records of patients referred by the emergency department to the adult first seizure clinic and seen by the same epilepsy specialist between June 2007 and June 2011. The diagnostic accuracy in the emergency department was calculated by comparing with the final diagnosis made by an epilepsy specialist. Results. In total, 219 patients were referred to the first seizure clinic. Median age was 45 and 60% of patients were male. From the cohort, 38 (17%) patients presented with seizure mimickers; the most common were reflex syncope (74%) and psychogenic non‐epileptic seizures (16%). From the remaining 181 patients presenting with seizures, only 110 (61%) of these patients were diagnosed with true first seizures, and 71 (39%) patients had evidence of previous seizures. Nineteen (17%) of true first‐ever seizures were provoked. The most frequent cause of provoked seizures was alcohol and illicit drugs (65%). In the emergency department, sensitivity and specificity in seizure diagnosis were 0.74 and 0.32, respectively. In our true first seizure patients, the EEG demonstrated epileptiform discharges in 22 (21%) patients. In the same cohort, computed tomography and magnetic resonance neuroimaging conferred 16% and 20% probability of finding a potentially epileptogenic structural abnormality, respectively. The most common epileptogenic abnormality found on magnetic resonance neuroimaging was cortical infarct. Conclusions. The diagnosis and management of first seizure remains challenging due to the variety of seizure mimickers and low yield of investigations. Our data highlight the potential pitfalls and practical challenges in this process, as well as the need for these patients to be assessed in dedicated first seizure clinics.

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“…The first EEG after the presenting seizure, a routine, non-sleep-deprived recording, was analysed and classified as being normal or abnormal with abnormalities defined as epileptiform or non-specific. CT and MRI scans were performed according to previously described standardised protocols 13. Neuroimaging abnormalities were defined as epileptogenic if a lesion likely relevant to the cause of the seizure was found.…”

Section: Methodsmentioning

confidence: 99%